Continuous Passive Motion

Continuous passive motionIt is a form of passive motion delivered via a motorized deviceDefined as Motion that is uninterrupted for extended periods of time it is usually applied by a mechanical device that moves a desired joint continuously trough a controlled range of motion.

Indication

Following open reduction internal fixation (ORIF)of an intra-articular fracture when the fracture fragment is stable/postdiaphyseal and metaphyseal fracture.Capsulotomy ,arthroplasty ,Ligament construction ,synovectomy, arthrotomy and drainage of acute specific arthritis Tendon reconstruction and burns

Benefits

CPM is effective in lessening the negative effect of joint immobilization in conditions such as -arthritis , -contracture ,-intra - articular fractures2.decreases the frequency of post operative complication 3.Improves the recovery rate and ROM following surgical procedure

CPM has shown toa. Prevents development of adhesion and decrease contracture formation b. Decreases postoperative painc. Enhances nutritional status of the extremity by improving the circulation d. Increasing synovial fluid lubrication of the joint e. Decreases joint effusion and wound edema and promote healingf. Increases the rate of intra-articular cartilage healing and regulationg. Provides a quicker return of range of motion

ProcedureThe device may be applied to the involved extremity immediately after surgery while patient is still under anesthesia or with in 3 days if the bulky dressings prevent early motion The size and position of the motion arc for joint is determined A low arc of 20-30 may be used immediately after surgery

The rate of motion is determined ; usually 1 cycle per minute or per 2 minutes is well tolerated The amount of time on CPM vary 24 hrs. continuously or continuously 1 hour 3 times a day Active assisstive or sling exercises is included Duration minimum 1 week or till satisfactory ROM is reached ,active exercises is continued until the patient attains appropriate functional goal

Goals 1.To maximize the biologic benefits stimulated through CPM*8-24 hrs for minimum of 3weeks 2. To help relieve pain,stiffness, swelling.

Safety Consideration To provide written CPM instructions to the patients caretaker whenever possible.Verbal explanation on the purpose of using of CPMinstructions on all setting indication on the deviceAlthough demonstration and explanation on proper limb positioning and limb relaxation Instructions to avoid pressure while strapping the limb to avoid circulatory and nerve irritation problems

ASSISTED EXERCISESSUSPENSION THERAPY

Types Assistance exerciseSelf assistance -patient can be taught to use the normal extremity to move the involved extremity through Range of motion Wand exercise when the patient has voluntary muscle control in an involved upper extremity but needs guidance or motivation to complete the range of motion e.g.-a dowel rod (cane , wooden stick,t-bar)can be used to provide assistanceFinger ladder- wall climbing is a device the patient with objective reinforcement and therefore motivation for performing ROM

D. Over head pulley it can be effectively used to assist an involved extremity in performing ROM

E. Skate board ; power board (can be used after surgical procedure to hip to encourage ROM

F. Suspension technique is used to free body part from the resistance of friction while it is moving

SUSPENSIONThe technique is use to free a body part from the resistance of friction while it is moving the part is suspended in a sling attached to a rope that is fix to an appropriate point above the body segment

Guthrie Smith

BENEFITS OF SUSPENSION FOR ROM EXERCISEActive participation is required thus the patient learn to use the appropriate muscle for desired movement Relaxation is promoted through secure support and smooth rhythmic motion Little work is required of stabilizing muscles because the part is supported Modification can be made to the system to provide grades of exercise resistance After instruction the patient can often work independently of a therapist

The fixed point It is made of stainless steel or plastic covered 5 cm metal mesh around the area of a plinth, Its1m or 2m wide x 2m long above it, 2m x 2m on the wall at the side of the plinth, At the head of the plinth 1m or m x 2m long and 2m high. suspend the overhead mesh from the ceiling at a height which will allow about 1.5m A free standing frame may be used. This is a frame big enough to take a single bed. Hooks on the side of the frame allow lateral fixed points and can be used to keep the small apparatus near at hand.

meshplinthFixed point

Storage trolley

The supporting ropes Ropes should be 3ply hemp(will not slip)3 types of ropes A single rope , a pulley rope, a double rope.

Single rope

A single rope has a ring fixed at one end, by which it is hung up The other end of the rope passes through one end of a wooden cleat, Then through the ring of a dog clipAnd through other end of the cleat and is then knotted with a half-hitch.

The cleat is for altering the length of the ropeAnd should be held horizontally for movement Should be pulled oblique when supporting The rope then holds on the cleat by frictional resistance The total length of rope required is 1.5m Further shortening of the rope may be brought about by knotting is about the cleat.

Pulley rope A pulley rope has a dog clip attached to one end of the ropewhich then passes over the wheel of a pulleyThe rope then passes through the cleat and a second dog clip.This rope is 1.5m long.This arrangement is used for reciprocal pulley circuits: with one sling supporting a limb, and the ends of the sling attached to the two dog clips, it is used for three-dimensional movements of a limb, i.e. abduction or adduction with flexion or extension and medial or lateral rotation (combined, oblique, rotatory movements).

Double rope A double rope consists of a ring and clip from which the rope is hung to create a compensating device permitting a certain amount of swivel on the rope.

The rope then passes through one side of a cleat,

around a pulley wheel at the lower end, to the case of which is attached to a dog clip,

Through the other end of the cleat and over the wheel of an upper pulley which is attached to the compensating device.

The rope then passes down again through a centre hole in the cleat where it is knotted This device gives a mechanical advantage Such a rope is used to suspend the heavy parts of the body the pelvis, thorax or heavy thighs when these are to be supported together

SlingsSingle slings Single slings are made of canvas bound with soft webbing and with a D ring at each end.

Used open to support the limbs

Can be folded in two, and as a figure of eight to support the hand or foot.

They measure 68 cm long by 17 cm wide

Double slings Double slings are broad slings measuring 68 cm long by 29 cm] wide with D rings at each end Used to support the pelvis or thorax or the thighs together,Three-ring slings Three ring slings are webbing slings 71 cm long by 3-4 cm wide with three D rings one fastened at each end and one free in the middle The center ring is for attachment to the dog clip The webbing is slipped through the end D rings to make two loops. These slings are used to support the wrist and hand or ankle and foot.

Head sling

A head sling is a short, split sling with its two halves stitched together at an angle to create a central slit. This allows the head to rest supported at the back under the lower and upper parts of the skull, in the side lying position leaves the ear free

Clips Karabiner hooks of 70 mm or 100 mm provide a convenient alternative means of clipping two pieces of equipment together.

TYPES OF SUSPENSION. Vertical fixation :vertical fixation the rope is fixed so that it hangs vertically above the centre of gravity of the part to be suspendedThe centre of gravity of each part of the body is, at the junction of the upper and middle third. The point of attachment of the rope is over the center of gravity of the moving segment. The part can then move like a pendulum, The movement is small range, This type of suspension is primarily used for support.

Axial fixation:This occurs when all the ropes supporting a part are attached to one S hook which is fixed to a point immediately above the centre of the joint The point of attachment of the all the rope supporting the part is above the axis of the joint to be moved The part will move on a flat plan parallel to the floor this type of fixation allows for maximum movement of the joint.

If some resistance to the muscle work is required

The whole fixed point is moved away from the muscles which require resistance. For e.g. If abduction is to be resisted the fixed point is moved towards the adductors. On effort the limb will now rise into abduction brought about by isotonic shortening of the abductors, resistance being offered by gravity.Slow lowering into the resting position is controlled by isotonic lengthening of the abductors

Suspension therapy is a form of assisted exercise Suspension therapy used in case of muscle power 2

Applications:Whenever using equipment the primary concerns must be GoalProper mechanism of moving segment Patient comfort and safety